Provider Demographics
NPI:1598752339
Name:LEE, ARYANNA F (MD)
Entity Type:Individual
Prefix:
First Name:ARYANNA
Middle Name:F
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-435-9800
Mailing Address - Fax:
Practice Address - Street 1:8057 SPYGLASS HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8565
Practice Address - Country:US
Practice Address - Phone:321-435-9800
Practice Address - Fax:321-434-9803
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13750OtherBCBS
FL5569738OtherCIGNA
FLAS717YOtherMEDICARE
FL263971800Medicaid